00060169 CITY OF CUPERTINO
BUILDING DIVISION PERMIT •t CONTRACTOR INFORMATION: '
BUILDING ADDRESS: PERMIT NO. ,
Klr 00060169
DIN.pg.,,AIjLR,6 HuNihKbr ON — MARTINEZ ROOFING ` APPLICATION SUB DATE '
PHONE_ MUNICH
4640 TAMPICO 110Y 06/26/2000
- - SANITARY NO. COMBOL NO. ..
J
�Q Oro AkCHIT[CT/ENGINF.ER: BUILDING PERMIT INFO
BLDG ELECT. PLUMB MFCH
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LICENSED CONTRACTOR'S DIiC1.ARAl'ION
ZO S= 1 hereby affirm mal 1 tun licensed-under provisions of Chapter 9(cammencins Job Description .
F:Cca with section 7000)of Division 3 of the Business and Profess ions Code,mtduty license -
¢�
at ❑ Is in full force and effect.
ie.�, a License Class Lie is RE—ROOF
iea V Date Contractor - .
ic ARCHITECT'S DECLARATION
si 1
understand my phmc shall be usal as public recants -
u�i q O Licensed Professional
OWNER-BUILDER DECLARATION
w_m I hereby chiral Iha(1 am exempt from it,,Cobtmemr'e License Law for the -
C < fallowing reason.(Section 7031.5,Business and Pmfcednns Code:Any city or connty
f
A❑ which reyulms a permit m constmcl,Later,improve, molish
de .u,territory structure '
A prior to its issuance,also requires the applicant for such permit to file a signed statement
hot hdislicensed pumnant to the provolone of the Contractors Licence Less(Chapter 9 Sq. Ft. Floor Area Valuation
•(moullancing wish Section AAAI)of Dist.ioin 3 of the Bnslnow and Profession.Code)
or that he is exempt Ilmrefrom and the has,,for me alleged exemption.Any violation
of Section 7031.5 by any applicant for a permit nthjects the applicant m a civil penalty
afactlram man five hundred dollars($50(g.. APN Number Occupancy Type
❑1,as owner of the propenly....my employees with wages uv the it sure compensation,
will do the work,and the stracmre'is not Intended or dromd far sole(Sec.794, - p
Business and Professions Cade.The Conlmmor'a License Law does not apply to an - - eglllCed Inspections
.senator pmperty Abs,bu ld a-improves Ihercon,and who does such work himself - • '
dr through his awn employee,provided that aveb impmvememe'ntr not intended or _ 305 — ,FRAME
altered iia ear.If,but the building Lir impmment v6Is sold within and yen,of „
completion,the owner-builder will have the burden of proving that he did not build or "
mprove for pmposebreLae). > 307 " INSULATION ' ,
Cl 1,.1 wL the property,amdxtun.ivelyformetin,verb licensed rumored no601 — ROOF YEAR OFF
ar(mcI the pmjert(see 7044,Basi nes and Professions Code:)The Contractor', ."60? — ROOF PLYWOOD NAIL
License Law does not appm ly an owner of property who hours or improves(hereon,
and who contracts for such prolcets with u contractors)licensed'pursuant w rhe
ContractorsIdealise Lit,. - 603' ROOF BATTENS
❑l am r_earam under Sao B do P C for his mature- 604 — ROOF IN—PROGRESS
Owner Dole .
WORKER'S COMPENSATION DECLARATION -
1
the d p IIY fe
Y d followingd atom: r
❑ I h f d it'll t Certificate f t t ll' f Wo Aer'.e
Comp t' p d d lot by Sect 3 3 700 of the Labor Calc for the
pert f ila k i h' I th' p tut d. ..// ��
❑M I TI Ira or k .C e rep I 4 q ' d by S e(inn -
3700 of the Labor Code.for the performance of the work for ur h this parmit is s ��
issued.My Workers C interactive lantroure courric,.md policy ey nu ober are /
Carrier: Policy IIO
ATION OF EPTIO
CERTIFICXEMN FROM WORKF,RS' -
COMPENSATIONINSURANCP.
-
(I my section need not be completed if the permit is for Linc hundred dollars -
($100)or Ie".)
I certify that in the perlomtance of the work for which miss permit is issued.1
shall nm e.,lay any ,an in any nm .o as m Italian, object to the Waream
p
Camer inion fates of California.Dom rte
Applicant I
NOTICE TO APPLICANT:If,after mo king this Carillonneur Exemption,you should
tZD,Q -become aliwed to the We for,Compensation pmvisinns of the Labor Code,you net
.forthwith comply with such provisinne unhi,permit shall be doomed or—lad.
r~/4 CONSTRUCTION LENDING AGENCY
I hereby affirm that there is if ea motion landing opme,for the performance
W > of the work for which this ,oil is issued ISec.3197,Civ.C) ,
(� Lender's Name
Z Loader's Address - .t
V I cerciB that I have read this application unit state(hill the above information is
W try cored(.I agree to comply with all city and county ordinances anti orate laws relating -
Q V 1st building coslinal e,and herehyamhoize representatives oftmiclly to enterupen -
y r� she chwa-mernmead property ty f r'au,,,am borrow, .
(W)ago.oni,fiva,indemnify ad ker,h I.umeCly ofCa,carmugam,
[Al liabilities,jLargincents,stop, I expense,whadi Lt.,to any way accord against said -
V City in automation,M five'formin,of0ii,mal
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT SOURCE SOURCE REGULATIONS. y:] db f `rC_•. Date 60
r _
Signature of Applican(ICuntracmr Date Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will the appdemr er future lwifdmg occul con.store or handle haaanh,as material Type of Roof .
Is defined by the Cupertino Municipal Code,Chapter 9.12,and the flaunt and Safety
Code"Section 25532(0)1 1 -
0YCs El No All roofs shall be inspected prior to any roofing material being installed: .
Will the applicant tit future bvildmgoccupant uLaoNuipmentordevices which -If a roof is installed without first obtaining an inspection, I agree to remove
coal hazardous air contaminants as defined by the Bay Area Air Quality Management
District) " ": - all new.materials for inspection. Applicant understands and will comply with
❑ ❑Yes No all non-poinf source regulations.
1 have read the h ti urdems materials reyu mormis tinder Copper 6.95 of the _
California Health Ad Safety Code,Sections 25505,25533 and 25534.'1 unddtnand that
If me hadding does not recently have a tenant,that it is mymsp risibility in maify me
occupant of the requirements which must be met prior h,issuance aid Comments of
Occupancy' ' ' - - Signature of Applicant Date
Owae,mr.offarisedagent - Date- All roof coverings tube Class `B"or-better
OFFICE- -